AB0841 Analysis of the functional state of hip joints (HJ) before total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS): data of a retrospective analysis
Authors: A. Dubinin, A. Khramov, T. Dubinina, E. Ilinykh, S. Maglevaniy, E. Bialik
Journal: Annals of the Rheumatic Diseases (2022)

Background Injury of hip joint (HJ) in patients (pts) with ankylosing spondylitis (AS) is considered as a factor of unfavorable prognosis, which can lead to rapid disability of pts. Objectives To assess the functional state of HJ before performing THA in patients with AS. Methods This retrospective study included 170 pts with a verified diagnosis of AS, who met the modified New York criteria of 1984, who were treated in the traumatological and orthopedic department in the period from 1998 to 2020, THA was routinely performed to all pts. Most of the pts were male (80.6%). 64% of them did not work due to the disease. Functional insufficiency of the joints at the time of surgical treatment in 64.1% of all the cases corresponded to III grade, in 26.5% - to IV grade, in 9.4% - to II grade. 82.9% of pts had low activity of the disease according to the BASDAI index at the time of surgical treatment and 17.1% of them had high activity. 53 (31.1%) pts were receiving bDMARDs and 87% of them were TNF-alpha inhibitors. The Harris quantitative scale was used to assess the functional state of HJ. Results: Parameter All patients (n=170) bDMARDs (+) n=53 bDMARDs (-) n=117 Age, years, Me±δ 38,1±11,3 37,5±12,3 38,3±10,8 Age of AS debut, years, Me± δ 20,7±8,4 21,2±8,4 20,5±8,4 Age at the time of diagnosis, years, Me± δ 27,6±9,1 27,6±9,9 27,6±8,9 Average delay in diagnosis, years, Me± δ 6,8±5,8 6,4±4,3 7,1±6,4 Average duration of the disease, years, Me± δ 17,0±8,5 16,2±8,0 17,5±8,7 Average duration of pain in HJ, years, Me± δ 7,4±4,8 6,1±2,2* 8,0±5,4 Average level of pain in HJ, VAS, Me± δ 72,3±14,0 69,9±12,9 73,4±14,5 Average overall score on the Harris scale before surgery 38,0±15,4 42,1±15,0 36,1±15,3 * The average level of pain on the Harris scale, VAS,, Me± δ 15,6±8,4 17,5±8,3 14,7±5,5 Antalgic Gait (absent/mild/moderate/severe), % 42,9/42,9/11,8/2,4 41,5/35,8/18,9/3,8 43,6/46,2/8,5/1,7 Walking a distance (unlimited /1500 meters /500 meters/in the apartment/unable to walk), % 2,4/21,2/0,6/44,7/27,1/4,1 2,4/21,7/44,7/27,1/4,1 3,4/21,6/45,2/26,4/3,4 Additional support (missing/walking stick for long distances/walking stick permanently/one crutch/two walking sticks/two crutches), % 30,6/5,3/4,1/29,5/4,1/26,4 22,6/7,5/3,8/24,5/7,5/34,0 34,2/4,3/4,3/31,6/2,6/23,0 Putting on shoes (without difficulty/ with difficulty/ impossible) 4,2/65,8/30,0 7,4/67,9/24,5 3,4/64,9/33,3 Fixed adduction (&lt;10°/&gt;10°), % 30,0/70,0 26,4/73,6 31,6/68,4 Fixed internal rotation (&lt;10°/&gt;10°) 22,9/77,1 26,4/73,6 21,4/78,6 Flexion contracture (&lt;15°/&gt;15°), % 39,4/60,6 41,5/58,5 38,5/61,5 * p&lt;0,05 Conclusion The vast majority of pts with AS had pronounced severe disorders of HJ before THA - the average score on the Harris scale was 38.0±15.4. Most of the patients (85.9%) had severe and moderate lameness, with the need for additional support in 69.4% of cases. Objective signs of functional disorders (fixed inward rotation and reduction, flexion contracture) of HJ were detected in more than half of the cases. According to the assessment of most parameters of the Harris scale, there were no significant differences between pts with AS on bDMARDs and without bDMARDs, except for the average duration of pain in HJ and the overall value of the scale (6.1±2.2 vs 8.0±5.4 and 42 vs 36, respectively, p&lt;0.05 in both cases). Disclosure of Interests None declared